Doctors strikes and their Moral Responsibility- ND Amerasekera

Doctors strikes and their moral responsibility

Dr Nihal D Amerasekera

Industrial action is when workers collectively refuse or reduce their work due to a dispute. It is often organised by a trade union when negotiations have failed. Common forms of industrial action include strikes and picketing. 

The British Medical Association is the doctors' trade union in Britain. Recently, the organisation has marshalled the junior doctors (now called resident doctors) to a series of strikes. This has seriously affected patient care in hospitals and has damaged the esteem and goodwill the patients have for the profession. The long-running dispute of the junior/resident doctors with the government started in March 2023. The BMA argues that resident doctors' pay is 20% lower in real terms than it was in 2008, even after the 2025 increase. There have been 14 strikes since, causing immense disruption to healthcare in the NHS. The government says resident doctors have received the largest pay rises of any public sector employees over the last three years - totalling nearly 30% - and insists the government won't offer any further increases.

The beginning of industrial action goes way back into the 17th century. Then the workers faced appalling working conditions and dangerously long hours. They earned such low wages. There were many accidents in the workplace due to the lack of safety regulations. In Britain, the Trade Union Act of 1871 legalised trade unions, giving workers a legal way to protect and advance their rights. This led to an increase in industrial activity which in turn improved the lives of workers. Workers strikes had the propensity to damage the economy of the country and cause hardship to the public.

The National Health Service was established in 1948 by Aneurin Bevan providing comprehensive medical care free at the point of use, funded through general taxation. An association for doctors was formed in 1832, and it was called the Provincial Medical and Surgical Association. In 1856, this organisation changed its name to the British Medical Association. For many years, as a profession doctors never struck work. The first doctors strike took place in 1975. Firstly, it was the consultants who went on strike to retain the privilege of private practice. Later that same year, the Junior doctors went on strike, wanting payment for their on-call duties. These instances of strikes have been notable for their scale and impact. They represent the largest and the most disruptive action seen in the 75-year-history of the NHS.

The Hippocratic Oath is an oath of medical ethics historically taken by physicians. It pledges to uphold professional standards, to help the sick, do no harm, and maintain patient confidentiality.

The original oath is often revised for modern use. The core principles of the oath still continue to guide the medical profession. The Declaration of Geneva was created by the World Medical Association in 1948.

World Medical Association Declaration of Geneva - 1948

The Physician’s Pledge

AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

I WILL RESPECT the autonomy and dignity of my patient;

I WILL MAINTAIN the utmost respect for human life;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I WILL RESPECT the secrets that are confided in me, even after the patient has died;

I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour and noble traditions of the medical profession;

I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely, and upon my honour.

Wherever I have worked I have seen the dedication of the doctors to patient well-being. They work long and unpredictable hours providing a selfless service. This often involves personal sacrifice. Money is a vital component of modern life. It provides security and stability, social inclusion and a better quality of life. We all want more of it and there are times we all feel that way. It is the responsibility of the government to pay the doctors adequately for the important work they do. The public too has a responsibility to force governments to provide adequate remuneration for the doctors for their work.

The medical profession is more than just a job. We all have an important duty of care to our patients. As doctors, we must not forget the core principles of our profession. The World Medical Association Declaration of Geneva (1948) is a useful reminder to all doctors of their responsibilities.

In the UK, pay review bodies are independent, non-departmental public bodies that advise governments on public sector pay. Their function is to gather evidence from various sources, such as government departments, unions, and employers, to provide independent, evidence-based recommendations on pay and working conditions. This advice helps the government set public sector pay levels that aim to attract, retain, and motivate staff. Governments are not legally bound by the recommendations. These review bodies sit annually to advise governments. Hence, the doctors' pay is reviewed every year and is adjusted when necessary. The British Medical Association has a significant input into the Review Body on Doctors' and Dentists' Remuneration.

Teaching and Higher Education Act 1998 allowed universities to charge tuition fees from students. Currently it is £9250 annually. When the cost of food and lodging is included, it adds an extra £10000. Hence the medical students when they complete their course could have a debt of £100,000. I hope the BMA and the Review Body take this into consideration when doing the pay review. I wish the BMA would do a deal with the government to waive the university tuition fees if medical students sign a contract to work for the government for 5 years after they qualify.

In the UK, doctors provide an excellent service, often beyond the call of duty. It must be said that those in the medical profession are under greater pressure than ever before. Their workload is increasing exponentially, and their work is more closely scrutinised. This adds to the stress in the workplace. We live in a litigious world and legal action against doctors is much more common now. Here, too, we assume that the review body is aware of these issues.

Strikes by doctors lead to the cancellation of appointments and postponement of elective surgery and other procedures. These cause significant delays and distress to patients. Depending on the cover provided by the striking doctors, the emergency and urgent care services will be restricted and there will always be inevitable unacceptable delays. Strikes disrupt the overall efficiency of the NHS, leading to longer waiting times and a higher risk of patient deterioration. Cancer diagnosis and treatment gets delayed. There is also a huge physical and emotional impact on the staff that work during the strike providing cover. The total impact on the NHS is huge.

While many organisations can strike, professions in the armed forces, police, and prison services are legally banned from striking. These are deemed as essential services and strikes by them would seriously disrupt and endanger life. Frontline medical services too are essential and will endanger life if withdrawn. I do not see why doctors are allowed to strike when the other essential services aren’t. 

As a medical professional who has worked in the health service both in Sri Lanka and the UK for 50 years, I feel strongly that doctors should not strike. There are adequate safeguards to keep their pay in line with the rest of the public sector. The British Medical Association should be negotiating with the government about pay and conditions, retaining their respect as a body that is committed to providing a good service to the public. The leader of the Conservative Party has said she would ban doctors from taking industrial action. It is indeed my personal view too that the medical profession provides an essential service and should not be allowed to strike.